Provider Demographics
NPI:1396907770
Name:J ANTHONY STEPHENS MD
Entity type:Organization
Organization Name:J ANTHONY STEPHENS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-767-7575
Mailing Address - Street 1:5233 DIJON DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4692
Mailing Address - Country:US
Mailing Address - Phone:225-767-7575
Mailing Address - Fax:225-768-7470
Practice Address - Street 1:5233 DIJON DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4692
Practice Address - Country:US
Practice Address - Phone:225-767-7575
Practice Address - Fax:225-768-7470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD021285208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DE50Medicare PIN
LAF05292Medicare UPIN